Stanford Medicine Newsletter Updates For the Local Community

Designing tomorrow’s hospitals

Physician-architect integrates technology with patient needs

Summer 2008

Play eases the anxiety of Bernard Dannenberg's young patient.

George Tingwald, MD, director of medical planning for Stanford’s Medical Center Renewal Project, says it’s essential to include input from health care providers, patients and architects in hospital design.

As a licensed physician and architect, George Tingwald, MD, is one of only a handful of people nationwide with the dual designations of MD and AIA (American Institute of Architects), and he has devoted his career to creating innovative health care environments.
Tingwald previously was director of health and science at the leading architectural firm Skidmore, Owings and Merrill LLP and served as the director of planning for California Pacific Medical Center’s five-campus master plan in San Francisco.

Tingwald speaks the language of physicians and care providers as well as the vernacular of architects and designers. In his role as director of medical planning for Stanford’s Medical Center Renewal Project, his fluency and translation skills provide unique perspectives on the full potential of designing hospitals for the 21st century. 

When did the notion of a “healing environment” become part of health care planning?

In the early 20th century, the creation of sanitariums for tuberculosis patients first introduced the idea that physical environments, where patients could benefit from fresh air and even sleeping porches, would enhance healing. Starting with the age of antibiotics, however, emphasis on the environment went by the wayside and the focus shifted to rapidly advancing medical treatments.

How has our understanding of the role that design plays in promoting healing changed?

Over the past two decades of my career, there has been an absolute revolution. What used to be considered wishful thinking is now fundamental to our understanding of how to design new health care facilities. We are returning to a more balanced view, informed by our knowledge of how social, psychological and environmental aspects of a patient’s experience actually impact physiology.

Is there proof that the physical environment influences healing?

Yes, and the concept is known as “evidence-based design.” There is strong scientific evidence, for example, supporting the advantages of single-patient rooms, which have been shown not only to provide better infection control but impact a wide range of issues, from improved comfort and privacy for patients and families to reduced medical errors related to transferring patients between rooms during hospitalization.

Have patients and families influenced medical and architectural planners? |

Their influence has been transformational. It began in the 1970s and ’80s when women began asking for (or should I say demanding) a more humane labor, delivery and recovery experience with a more homelike atmosphere. Children’s hospitals led the way in recognizing the importance of involving families and introduced innovations such as rooming in and family-centered care. These innovations have now expanded to include all areas of care for all types of patients.

How are these concepts influencing the design of the new Stanford Hospital and the expansion of Lucile Packard Children’s Hospital?

Single-patient rooms are the new standard, and the potential for rooming in by family members will be available in every room. Our goal is to create hospital rooms that are as much like the home environment as possible. Today that means providing the same kind of information, communication and entertainment technology that people have in their homes. We are designing family-friendly, comfortable rooms that will also allow families at the hospitals to communicate with friends and relatives.

What role does the outdoor environment play and how is that a special consideration here?

This is a truly extraordinary physical environment, with weather, views and sunlight that simply are not present elsewhere. It offers us the opportunity to bring these unique outdoor experiences inside and to make healing gardens, contemplative outdoor spaces and breathtaking views integral to what our patients, visitors, caregivers and staff will experience.

To describe a setting as being “like a hospital” generally means cold, sterile and institutional.  How is that changing and why?

Health care is learning from other sectors in which the design of environments is very important. For example, the hospitality industry has taught us that people form their impressions of quality very quickly upon arrival, often in the first few minutes. The experience of parking, entering a lobby and encountering a place that welcomes and reassures rather than intimidates and confuses is critical. 

What other factors are involved in designing the hospital rooms of the future?

A key concept is acuity adaptability, also sometimes referred to as universal design. Essentially this means that we want to be able to keep patients in the same room while their medical status changes during a hospital stay.

There are also important considerations for elderly patients to help prevent falls. For example, do you locate the bathroom close to the head of the bed for ease of access (which would be typical in an acute-care setting) or opposite the bed so that the patient can see it? Studies have shown that visibility is just as important as distance for the increasing numbers of elderly patients we will be serving in the years ahead.

How can we design today for advances we cannot even imagine?

Fortunately, human nature and interpersonal dynamics change very slowly, so we focus design on these fundamental responses. By focusing on the underlying issues rather than on how we respond to specific diseases with specific current technologies, we can design hospitals at Stanford today that will serve our community for decades and always assure that the most advanced treatments and technologies will be available here first. That is both our challenge and our commitment.

For more information and updates on the Medical Center Renewal Project, visit the project Web site, www.stanfordpackard.org.

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